Wednesday, May 04, 2005

Astonishingly weak indeed

Colby Cosh had this to say Monday about Tart Cider: "I don't even know what the heck Torontonian Chris Selley does for a living, but he's great." I tend to agree, which is why Selley's post about the teenaged Jehovah's Witness with cancer disappoints me that much more.

Minor quibbles first: there is not a good analogy between this case and Terri Schiavo. I would never speak for religious conservatives, but from where I sit, it's entirely different because we are crystal clear about the wishes of both the patient and the guardians. Schiavo's parents were arguing expressly that she was minimally conscious, and expressing her wish to live ("ahhhhh! waaaaa!" etc.). So the issue here is nothing about what the patient would want, and entirely about whether those wishes should be ignored.

Also, does refusing a blood transfusion against the unanimous recommendation of doctors qualify as irrefutably loony? Obviously Selley and most Canadians think it does; I do not, I don't expect to change anyone's mind, and that's not the aim of this post. However, I think it behooves us all to consider the question of whether there are worse things than death.

This doesn't require a religious perspective at all. I would guess that for nearly all of us there exists certain potential agonies, humiliations, or heartbreaks which we would assess as being less preferable than death. Thinking of some? Good - now imagine that someone else's list is different than yours. Would you replace his list with your own if you had the power, for his own good? Should we all take a vote on it? Maybe he feels the same way - should we all take a vote on your list?

This is mostly barking at the moon; legal precedent favouring the government is ample on the JW/minor/blood transfusion question. However, as usual, we should check our premises--and be reminded that deciding for someone else, child or not, what is better than death is a grave step to take.

All that said, what is most offensive about Selley's take is easily this portion:
I don't have much of an activist bent, but I'll lay my cards on the table here: we need to find this girl and take all medical steps possible to save her life. The arguments against doing so — including her own, I'm sorry to say — are astonishingly weak:

It's no different than somebody getting sexually assaulted or robbed or something. You'd feel violated because it's not anybody else's property, it's you.

Well, that does sound rough. But it's rather ironic, as one blogger observed, that:

This [comes] from a girl who has ingested drugs, had chemo, gotten through two surgeries and accepted the possibility of having her leg amputated.

Furthermore, while it may be like rape, assault and robbery, at least it's not like murder.

Ironic? What the fuck? Here's irony--read the entire paragraph written by "Charlie Quimby", the blogger whose observation Selley notes:
This from a girl who has ingested drugs, had chemo, gotten through two surgeries and accepted the possibility of having her leg amputated. Lifesaving blood is different because the Bible says so. I might differ on that point, but not with her position that having something inserted in your body against your will is like rape.

Even Quimby is explicit that there is a distinction associated with consent; regrettably, Selley offers no clue that he sees one. (This girl is willing to undergo some types of medical treatment but not others, whereas I would make a different choice. How ironic! It's almost like we're two different people!)

There is irony to be found here, though. How about this: there are undoubtedly Jehovah's Witnesses who today would be much sicker, or dead, if it weren't for their (cough) lunatic dogma against receiving blood transfusions.

And how's this for irony: sneering at a girl's comparision of a blood transfusion to sexual assault ("well, that does sound rough"), then expressing your wish to "track her down, strap her to a table and pump her full of medical science."

That's just brutal. Although we may have figured out Selley's job - is it M.D.? Because it's hard to imagine why else he would give so much creedence to the notion of doctor-as-God.

An otherwise unremarkable act performed in the absence of consent is serious stuff. This also brings up another point: while a 14-year-old has barely more legal right to run their own lives than a 4-year-old, it's not the same thing. A young JW child forced into a blood transfusion would not understand much of what was happening, would not appreciate the consequences in any meaningful sense, and stands a good chance of forgetting about the whole thing a few years down the road.

No such luck with a 14-year-old. She's going to be traumatized. Furthermore, how does she go about putting it behind her? "Living with the reminder" seems like the appropriate phrase here. Maybe, per Selley's hope, she'll grow up and "realize how stupid and backwards and nutty her parents' religion is", and find peace. Maybe she'll be so overcome with self-loathing that she jumps off a bridge. Maybe she'll be mostly OK, but will battle depression for the rest of her life. I don't know, but the idea of doing this risk-benefit analysis for someone I don't even know makes me queasy.

There is a base premise here that >90% of us could agree on: "There are certain extraordinary circumstances under which the state is justified in removing children from the care of their parents." We would all disagree on what constitutes extraordinary, but we generally agree that children have certain rights beyond what their parents may choose to bestow on them, and we ought to ensure that these rights are respected.

Selley has done a dismal job of asserting that this is one of those extraordinary circumstances, principally because he demonstrates no humility in vetoing the choices of the girl and her parents.

This is by most accounts a normal girl with a solid family structure. She does not "wish to die": she has pursued all other avenues of treatment, and is continuing to do so. Her refusal to accept someone else's blood is in accordance with the well-known beliefs of a religion that's been around for 100+ years. She would suffer an unknowable amount of emotional trauma if she is forced to accept the transfusion. Although we believe (probably correctly) now that a transfusion carries no real medical risk, there are presently thousands of Canadians waiting to be compensated for diseases contracted that way in the 80s and 90s. And by the way, forcing a blood transfusion into this may well discourage those like her in the future from seeking medical treatment at all.

On the other hand, the best medical knowledge we have in 2005 strongly indicates that the girl's immediate physical health would be best served by having a blood transfusion.

This is serious business. If you want to argue that various bits of prevailing medical wisdom ought to override the wishes of the patient and her parents, I'm listening. I'm objecting, but I'm listening. But don't come at me with this weak crap where not only do a doctor's orders amount to the word of God, but that all other considerations are comparatively so trivial as to be meaningless. A good doctor, after all, is supposed to treat the patient, not the illness.

Peace be with you, dear.


At 9:32 a.m., Blogger Jay said...

Well said. I hope to finally have some thoughts up on the matter later this week.

At 11:03 a.m., Blogger Chris Selley said...

I'll have more to say later, but for now: what's with the Hep-C thing? Come on. My cardiologist might leave a sponge in me during my triple bypass. Should I therefore take my chances?

At 11:06 a.m., Blogger Matt said...

How about, "That's up to you."

At 11:32 a.m., Blogger Matt said...

Specifically, this is what's with the Hep-C thing: if you are going to make the argument that declining a blood transfusion is medically illogical (which it certainly seems to be), you have to at least acknowledge that there are unknown risks associated with the procedure that we can't quantify.

Less than 15 years ago, people were infected with a serious disease via blood transfusion. To argue that since that time, the safety of receiving someone else's blood has gone from "seriously lacking" to "100% and permanently safe" is not only arrogant, it's scientifically untenable.

That said, as I hope I made clear in the main post, these are not the key terms on which I think this issue should be debated.

At 12:57 p.m., Blogger deaner said...

Matt - excellent post. I was also disappointed in Chris Selley's analysis of the issue, but I had not taken the time (and don't have the talent) to make my argument as clearly as you have done.

Since then, we have seen a judge in Ontario order the child and her parents to return to BC to continue her treatment. I dunno but that seems to inerfere with inter-provincial mobility rights. I think there is a fundamental argument that at least some people have the right to refuse medical treatment for any reason - even one that strikes you (or me) as patently absurd. In the normal course, we refer to those people as adults. When certain citizens have diminished capacity to act in their own interests, either due to incapacitating injury, dementia, or lack of maturity, we empower other people to act for them. When the lack of capacity is due to their young age, the people who are required to act in the best interests of the child are their parents. No doubt, the parents of this girl did so, at least by their own lights. To the extent that her opinion matters (and at 14, it should at least matter a little), she seems to agree.

The BC judge has now determined that the parents aren't capable of fulfillling their duty, and he has stepped into their place. I don't see that there is a legal basis for this - he has contorted himself to come to the conclusions he did because he (understandably) hates the thought that a young girl might die and he disagrees with the choice that the parents made. What if, instead of a "simple" blood transfusion, they had declined an agonizing and painful treatment with limited chances of success on the grounds that their child had already suffered enough and a peaceful death would be a blessing? Would he be so quick to step in and determine the "right" choice for a child and family he does not know, over their clear, and firmly-held objections?

It is a cliche that 'hard cases make bad law' - and in this instance we have a judge giving us bad law in order to escape from a hard case. Unfortunately, judges in particular are supposed to know that 'good law' is important - even more important than "protecting" a young girl from her own and her parent's religious beliefs.

He has let us all down.




Post a Comment

<< Home